Aspiration alone versus aspiration and bupivacaine injection in the treatment of undisplaced radial head fractures: A prospective randomized study

Hypothesis

Some physicians advocate that aspiration of elbow joint hematoma in radial head fractures is helpful not only for determining a mechanical block to motion from a fracture fragment but also for improving the elbow motion and pain. However, the supplementary role of intra-articular anaesthetic injection is unclear.

Materials and methods

In this prospective randomized study, 40 patients with undisplaced radial head fractures (Mason I) were treated with elbow joint aspiration alone (20 patients) or aspiration plus intra-articular injection of 3 mL of bupivacaine 0.5% (20 patients). Active elbow exercises were immediately commenced. The patients were evaluated at 1 day, 1, 3, and 6 weeks, 3 and 6 months, and 1 year.

Results

No difference was found in terms of range of motion, pain and elbow function between the 2 groups in all the examined time points. The improvement in the above parameters achieved a plateau at 3 weeks in both groups.

Discussion

Intra-articular use of local anaesthetic after joint aspiration does not offer any benefit over aspiration alone in the treatment of undisplaced radial head fractures and its routine application is not supported by the clinical data.

Level of evidence

Level 1.

Keywords: Radial head fracture, undisplaced, aspiration, hematoma, bupivacaine